MULTIPLE CHOICE
Ajlnursejlisjlcompletingjlajlcarejlplanjlforjlajlchildjlandjlisjlfinishingjlthejlassessmentjl
phase.jlWhichajl ctivityjlisjl notjlpartjlofjlajlnursingjlassessment?
a. Writingjlnursingjldiagnoses
b. Reviewingjldiagnosticjlreports
c. Collectingjldata
d. Settingjlpriorities
ANS:jlD
Settingjlprioritiesjlisjlajlpartjlofjlplanning.jlWritingjlnursingjldiagnoses,jlreviewingjldiagn
osticjlreports,ajl ndjlcollectingjldatajlarejlpartsjlofjlassessment.
DIF:jlCognitivejlLevel:jlComprehensionjlREF:jlp.jl19
OBJ:jlNursingjlProcessjlStep:jlPlanningjlMSC:jlPhysiologicaljlIntegrity
Whichjlpatientjloutcomejlisjlstatedjlcorrectly?
a. Thejlchildjlwilljladministerjlhisjlinsulinjlinjectionjlbeforejlbreakfastjlonjl10/31.
b. Thejlchildjlwilljlacceptjlthejldiagnosis jlofjltypejl1jldiabetesjl mellitusjlbeforejldischarge.
c. Thejlparentsjlwilljlunderstandjlhowjltojldeterminejlthejlchildsjldailyjlinsulinjldosage.
d. Thejlnursejlwilljlmonitorjlbloodjlglucosejllevelsjlbeforejlmealsjlandjlatjlbedtime.
ANS:jlA
,Thejloutcomejlisjlstatedjlinjlclientjlterms,jlwithjlajlmeasurablejlverbjlandjlajltimejlframejlfo
rjlaction.jlThejlverbjlacceptjlisjldifficultjltojlmeasure.jlThejlgoaljlofjlacceptingjlajldiagnosisj
beforejlhospitaljldischargejlisjlunrealistic.jlOutcomesjlshouldjlbejlstatedjlinjlclientjlterms.jl
l
Nursingjlactionsjlarejldeterminedjlafterjloutcomesjlarejldevelopedjl injlthejl implementati
onjlphasejlofjlthejlnursingjlprocess.
DIF:jlCognitivejlLevel:jl ApplicationjlREF:jlp.jl20
OBJ:jlNursingjlProcessjlStep:jlPlanningjlMSC:jlSafejlandjlEffectivejlCarejlEnvironment
MULTIPLEjlRESPONSE
Ajlnursejlisjlreviewingjlthejlnursingjlcarejlplanjlforjlajlhospitalizedjlchild.jlWhichjls
tatementsjlarecjl ollaborativejlproblems?jlSelectjlalljlthatjlapply.
a. Riskjlforjlinjury
b. Potentialjlcomplicationjlofjlseizurejldisorder
c. Alteredjlnutrition:jlLessjlthanjlbodyjlrequirements
d. Fluidjlvolumejldeficit
e. Potentialjlcomplicationjlofjlrespiratoryjlacidosis
ANS:jlB,jlE
Injladditionjltojlnursingjldiagnoses,jlwhichjldescribejlproblemsjlthatjlrespondjltojlindepe
ndentjlnursingjlfunctions,jlnursesjlmustjlalsojldealjlwithjlproblemsjlthatjlarejlbeyondjlthejls
copejlofjlindependentjlnursingp
jl ractice. jlThese jlarejlsometimesjltermedjlcollaborative jlp
roblemsphysiologicaljlcomplicationsjlthatjlusuallyjloccurjlinjlassociationjlwithjlajlspecif
icjlpathologicaljlconditionjlorjltreatment.jlThejlpotentialjlcomplicationsjlofjlseizurejldiso
,rderjlandjlrespiratoryjlacidosisjlarejlphysiologicaljlcomplicationsjlthatjlwilljlrequirejlphy
sicianjlcollaborationjltojltreat.jlRiskjlforjlinjury,jlalteredjlnutrition,jlandjlfluidjlvolumejlde
ficitjlwilljlrespondjltojl independentjl nursingjl functions.
DIF:jlCognitivejlLevel:jl ApplicationjlREF:jlp.jl20
OBJ:jlNursingjlProcessjlStep:jlPlanningjlMSC:jlSafejlandjlEffectivejlCarejlEnvironment
Whichjlnursingjlactivitiesjldojlnotjlmeetjlthejlstandardjlofjlcare?jlSelectjlalljlthatjlapply.
a. Failurejltojlnotifyjlajlphysicianjlaboutjlajlchildsjlworseningjlcondition
b. Callingjlthejlsupervisorjlaboutjlstaffingjlconcerns
c. DelegatingjlassessmentjlofjlajlnewjladmitjltojlthejlUnlicensedjlAssistiv
ejlPersonneljl(UAP)
d. AskingjlthejlUnlicensedjlAssistivejlPersonneljl(UAP)jltojltakejlvitaljlsigns
e. Documentingjlthatjlajlphysicianjlwasjlunavailablejlandjlthejlnursingjlsup
ervisorjlwasjlnotified
ANS:jlA,jlC
, Ajlnursejlwhojlfailsjltojlnotifyjlajlphysicianjlaboutjlajlchildsjlworseningjlconditionjlandj
delegatingjltheajl ssessmentjlofjlajlnewjladmitjltojlajlUAPjldojlnotjlmeetjlthejlstandardjlof
l
jl care.jlCallingjlthejlsupervisorjlaboutjlstaffingjlconcerns,jlaskingjlthejlUAPjltojltakejlvi
taljlsigns,jlandjldocumentingjlthatjlajlphysicianjlcouldjlnotjlbejlreachedjlandjlthejlnursin
gjlsupervisorjlwasjlnotifiedjlalljlmeetjlthejlstandardjlofjlcare.
Ajlnursejlisjlreviewingjlchangesjlinjlhealthcarejldeliveryjlandjlfundingjlforjlpediatri
cjlpopulations.W
jl hichjlcurrentjltrendjl injlthejlpediatricjlsettingjlshouldjl thejlnursejlexp
ectjltojl find?
a. Increasedjlhospitalizationjlofjlchildren
b. Decreasedjlnumberjlofjluninsuredjlchildren
c. Anjlincreasejlinjlambulatoryjlcare
d. Decreasedjlusejlofjlmanagedjlcare
ANS:jlC
Onejleffectjlofjlmanagedjlcarejlisjlthatjlpediatricjlhealthcarejldeliveryjlhasjlshiftedjldramat
icallyjlfromjltheajl cutejlcarejlsettingjltojlthejlambulatoryjlsetting.jlThejlnumberjlofjlhospital
jl bedsjlbeingjlusedjlhasjldecreasedjlasjlmorejlcarejlisjlprovidedjlinjloutpatientjlandjlhomejls
ettings.jlThejlnumberjlofjluninsuredjlchildrenjlinjlthejlUnitedjlStatesjlcontinuesjltojlgrow.jl
Onejlofjlthejlbiggestjlchangesjlinjlhealthcarejlhasjlbeenjlthejlgrowthjlofjl managedjlcare.
DIF:jlCognitivejlLevel:jlComprehensionjlREF:jlp.jl3
OBJ:jlNursingjlProcessjlStep:jlPlanningjlMSC:jlSafejlandjlEffectivejlCarejlEnvironment